Active Euthanasia

Active Euthanasia

An analysis of the arguments for Active Euthanasia (doctor-assisted suicide) and rebuttals against it.

Introduction
The question of the permissibility of “active euthanasia”, the act of killing a human being directly and intentionally with the assistance of a medical professional, remains one of the most difficult questions for moral philosophers, and for present governments to answer. Proponents of active euthanasia prefer to call it “mercy-killings”, arguing that euthanasia protects a citizen’s right to die, and is morally permissible because it would end the extreme pain from which the citizen is suffering. Proponents of active euthanasia also argue that it is merely an aid for those who would otherwise have committed suicide, a practice that is not in itself illegal in Canada . The purpose of this paper, however, is to contest that active euthanasia denies a citizen’s right to live, it denies the person’s right to be protected from harm, it does not guarantee the safety of patients who may have been misdiagnosed, it does not leave room for the unaccountability of human emotion, and it devalues life.

NOTE: This paper is specific to Canadian law, though the arguments being addressed are fairly generic with respect to ACTIVE euthanasia and hold regardless of location. This paper, however, does not address passiveeuthanasia, which is allowing someone to die, but not physically aiding them in doing so. Such an issue warrants its own piece separate from this one.

The Value of Life

In order to argue that active euthanasia devalues life, one must argue why one should value it in general. Humans traditionally attribute great value to life. Some will argue that life is valued merely because one’s care for it gives the person reason or justification for her/his actions. From a religious perspective, all three of the world’s major religions, Christianity, Judaism, and Islam, all agree that life must be valued since it is a gift from God. From an evolutionary perspective, a person must value life because her/his prime concern should be survival and procreation; suicide opposes intrinsically defies both of these, as it disallows further procreation, and a dead person can no longer aid in the preservation of humanity. One could also argue that if life is not of value, then one should not look at murders, pogroms or holocausts in disgust, as they are merely killing valueless lives. It is not unreasonable to state that a very large majority of the world’s citizens strongly condemn all three of those. If they did not, organizations such as the United Nations would not exist, nor would laws about such things exist. Certainly, one can argue against technicalities in the phrasing of these presuppositions, but it is felt that it is not an unreasonable supposition that the majority of humans value life. This supposition is presumed true for the purposes of this paper.

Abuse Potential: Slippery Slope?

Absolute legalisation, or even permission for specific instances of euthanasia, allows for abuse. That is, if one allows “acceptable reasons” for euthanasia, it would not be difficult for both patients and doctors to exploit the system, and defining what are “acceptable” deaths would prove very challenging. Patients may look for any way with which they can fit themselves into the criteria, and doctors, administrators and health systems may be influenced by incentives they could acquire by serving those patients. Naturally, one could contest that this argument exhibits all the characteristics of the “slippery-slope” fallacy, and indeed, it does. One should note, however, that it is precisely because of this reasoning that our laws regarding murder are so stringent – if there are specific cases other than mental diseases for which we make exceptions to our murder laws, it is not unreasonable to expect that those accused of murder will, for care of their own welfare and fear of punishment, actively pursue those “loopholes”.

Case Study: Netherlands

Furthermore, the fear of the result of legalization is not unjustified; one need only look at a country in which active euthanasia is legal, such as the Netherlands, to see the reason for concern. For a person to die by euthanasia there, courts decided that those suffering from unbearable suffering that could not be treated otherwise and persistently requested it, could choose to die by euthanasia. In 1990, it was found that 2 700 people died by euthanasia, 1 000 of these people died by active euthanasia. Of these, 60% made their wishes known in some form of writing, but not by the standard that their health association required. The remaining 40% had not expressed a desire to have their lives terminated. Of course, it could be argued that some of these patients had expressed a desire to die, but not officially; that does not speak, however, for those who did not desire their death at all. Let us even grant that all of these 400 people had requested death but not officially; the mere fact that in 40% of all cases, neither the patients nor their doctors complied with the laws regulating the practice and had no legal documents to support their cases in any form, indicates the facility with which the system can be abused. (Statistics can be found in Barney Sneiderman and Joseph M. Kaufert, eds. , Euthanasia in the Netherlands: A Model for Canada? , Legal Research Institute of the University of Manitoba, 1994, chapters 1 – 3.)

Preservation and Protection of Others’ Lives; Which Lives are of Value?

Canadian law puts a great emphasis on the preservation and protection of the lives ofothers ; it values life. Because of this, Canada does not permit capital punishment, it plays an active role in peace-keeping, and avoids all wars when possible. For this reason it odd that in 1972, Canada decriminalised suicide – an act which suggests the opposite, and will be discussed later. It is precisely for this zero tolerance of crimes committed against others, and our value of life, that Robert Latimer was not acquitted for the “mercy-killing” of his daughter, and is also why suicide is still looked upon with horror (despite its decriminalisation). Latimer felt that his daughter was in so much pain because of her brutal disease that she deserved permanent relief from her suffering. Since she could not request it herself, Latimer took it upon himself to decide for her. This type of active euthanasia is condemned even by most proponents of active euthanasia, but it is an important topic to discuss, because it raises an important question: Who can speak for a victim of pain if the victim does not have the ability to speak for her/himself?

In answer to this question, it is clear that proponents of active euthanasia would have a very difficult task in deciding whose life should be taken, and whose should not be taken. It has been mentioned that they do not claim that a person can speak on behalf of someone else; however, this [convenient] position to take is somewhat unreasonable. Without a doubt, making laws to cover all cases of active euthanasia would be extremely difficult. By refusing to argue for specific cases of euthanasia, one avoids (either intentionally or unintentionally) addressing the fact that the government must make specific laws to address Canadian citizens’ value of life. Making the laws very generic allows for abuse, and may cause unnecessary loss of life. This is not a slippery slope argument, as it is the government’s duty to protect its citizens and provide a system of order – that is the very reason we have laws.

Let us look at a very common scenario: a patient is terminally ill and hospitalised. Her hospital stay costs multiple thousands of dollars each night. There is no chance she will improve, but she simply wants to continue to live. She wants to see her family and interact with them. Forget family, she simply is happy to live. What is to stop staff, family members or other stakeholders from pressuring a person to end one’s life? If a person is surrounded by persons telling them, “You have lived a good life, why go through this pain?” There begins to be an enormous pressure on the patient to comply, save mention the mental anguish that ensues.

Argument: The Patient Requests to Die

Proponents of active euthanasia argue that the case of Robert Latimer is an exception, that there are cases where the patient her/himself will request to die. In fact, they argue that it is “criminal” to allow them to continue to suffer. Opponents of active euthanasia do not deny the fact that there will exist situations in which the person is in tremendous pain, be it psychological or physical. It is argued, however, that it is not necessary to take the life of the human being in order to end their suffering. It is better, because humans value life, to end a person’s pain, not the person’s life. The counter-argument is of course, that opponents of active euthanasia cannot guarantee that the patient’s pain can always be relieved. Again, opponents do not deny this.

Rebuttal: Variability of Human Emotion, Right to Protection from Harm

Concurrently, however, a proponent of active euthanasia can give no greater guarantee that the patient will not undergo a change of heart , and decide the next day, or even within five minutes, that she/he no longer wishes to die. Human emotions are variable under time, pressure, and environment. If one removes a cheerful person from a spacious, moderately heated room, and places him in a tight, overly heated room, it has been shown that he will be in a much less cheerful mood than he was previously. Furthermore, active euthanasia would deny the patient the right of being protected from harm, it would provide no protection for a patient who has been misdiagnosed, and it would violate the oath that doctors take to preserve the lives of their patients. It is also worth noting that cases in which pain cannot be alleviated are very few.

The decriminalisation of suicide, however, presents a great difficulty for opponents of active euthanasia, as the system appears quite contradictory with respect to this law. The contradiction becomes evident when supporters of active euthanasia argue that because suicide is not a criminal offence, neither should active euthanasia. They argue that a person seeking active euthanasia would kill himself, but he cannot, so he merely needs help in doing so. This argument seems both sound and valid, but there is a complication in the law. Despite the fact that suicide has been decriminalised, one is not allowed to assist, help, or even counsel someone into committing suicide. In fact, if a police officer sees someone ready to commit suicide, the officer is required to intervene as forcefully as necessary to prevent the person from following through with the act. In fact, if the officer does not intervene, the officer can be charged for “aiding, counselling, or abetting” suicide, which breaches the criminal code of Canada . In other words, it is a criminal offence notto intervene in someone’s choice to end her/his life. Because of this clear contradiction, it is no more valid for a proponent of active euthanasia to argue that because suicide has been decriminalised, so should active euthanasia, than it is for an opponent to argue that because active euthanasia has been criminalised, so should suicide.

Opponents of active euthanasia argue that the government decriminalised suicide for reasons of practicality, not morality. Of course, there is a degree of difficulty associated with prosecuting a corpse. Prosecuting someone who already sees her/his life as a form of “punishment” is equally impractical and is not likely to have any “positive” effects on either the person or society as a whole. Because of society’s value of life, it is generally agreed that those whose attempts fail should seek medical and psychological attention. This agreement, again, is not without basis; according to Statistics Canada, only 9% of those who were hospitalized for attempting suicide attempted it a second time. Clearly, because of attention and care, the other 91% of the patients experienced a change of heart . This is at least indicative that one should not so hastily move toward killing the person.

Conclusion

Active euthanasia should not be morally permissible. Not only does it violate the oaths that medical doctors make before entering their profession, but it is also very susceptible to abuse, as demonstrated by the Netherlands case study. Proponents are willing to change the law for the sake of the minority of patients whose pain cannot be alleviated at all, but they neglect to take other serious cases into consideration. They do not consider the minority of patients who are misdiagnosed – lives that are of equal value, and citizens who also deserve the right to live even if their doctors have made mistakes. They do not fully take into consideration Canadian statistics that indicate that the majority of suicidal citizens, citizens desiring death, experience a change of heart after their psychological pain is alleviated through therapy and clinical help. They do not take into consideration the variability of human emotion ; a person is likely to desire or behave uncharacteristically – even request death, depending on her/his internal and external environments. Active euthanasia neglects that variability and environmental/situational effects, and focuses on killing the person rather than the pain. Eliminating pain allows us to preserve human life, which Canadian law puts a great emphasis on, because its citizensvalue life . Canadian law has an obligation to protect every patient; the allowance of active euthanasia violates this duty.